Pain Management for Gastrointestinal Conditions in Exotic Animals

Gastrointestinal (GI) disorders are very common in exotic animals, such as reptiles, birds, mammals, and can be extremely painful. This review aims to provide the reader with a better understanding of the different pain mechanisms and manifestations across orders and species in order to provide the most updated information on pain recognition and management for GI conditions in exotic animals.

A Critical Review on the Pharmacodynamics and Pharmacokinetics of Non-steroidal Anti-inflammatory Drugs and Opioid Drugs Used in Reptiles

Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are analgesics used for moderate to severe pain in many animals, including reptiles. However, reptilian dosing regimens are often extrapolated from other animal species. This is not ideal as inter- and intra-species variability in physiology may result in varied drug disposition. Therefore, this critical review aims to collate data from pharmacological studies of selected NSAIDs and opioids performed in reptile and provide an analysis and discussion on the existing pharmacodynamic knowledge and pharmacokinetic data of NSAIDs and opioids use in reptiles. Additionally, key pharmacokinetic trends that may aid dosing of NSAIDs and opioids in reptiles will also be highlighted. Most of the existing reports of NSAID used in reptiles did not observe any adverse effects directly associated to the respective NSAID used, with meloxicam being the most well-studied. Despite the current absence of analgesic efficacy studies for NSAIDs in reptiles, most reports observed behavioural improvements in reptiles after NSAID treatment. Fentanyl and morphine were studied in the greatest number of reptile species with analgesic effects observed with the doses used, while adverse effects such as sedation were observed most with butorphanol use. While pharmacokinetic trends were drug- and species-specific, it was observed that clearance (CL) of drugs tended to be higher in squamates compared to chelonians. The half-life (t_1/2) of meloxicam also appeared to be longer when dosed orally compared to other routes of drug administration. This could have been due to absorption-rate limited disposition. Although current data provided beneficial information, there is an urgent need for future research on NSAID and opioid pharmacology to ensure the safe and effective use of opioids in reptiles.

COMPLETE UNILATERAL MAXILLECTOMY IN A COHORT OF FIVE COLOMBIAN BOAS (BOA IMPERATOR)

Five unrelated adult Colombian boas (Boa imperator) presented with a 1- to 3-mon history of unilateral rostral swelling of the maxilla associated with a chronic rubbing against the enclosure's walls. Moderate to severe gingival inflammation and ulceration of the labial mucosa were present at the level of the swelling with tenderness to the touch. Radiography revealed osteolytic or proliferative lesions of the maxillary bone. Chronic maxillary osteomyelitis was diagnosed. Unilateral maxillectomy was performed on each animal under general anesthesia. Local anesthesia was also achieved by infiltrating lidocaine along the medial and lateral aspect of the maxillary gingiva and at the level of the maxillo-ectopterygoid joint. Using a lateral gingival approach, the maxillo-prefrontal, maxillary-palatine, and maxillo-ectopterygoid attachments were transected, and the maxillary bone removed. Histologic examination revealed pyogranulomatous stomatitis and osteomyelitis in all snakes, and presence of intralesional bacteria (n = 3 snakes). Gram-negative bacteria (Chryseobacterium indologenes and Proteus mirabilis) were cultured from the resected tissue of two snakes. One snake suffered from wound dehiscence 5 d postoperatively. All snakes were fed 15 d postoperatively and ingested dead mice without apparent difficulties. One snake was examined 2 mon and 1 yr after surgery, with no evidence of soft tissue or osseous infection and only minor facial scaring; all other snakes were lost to follow-up 15 d after surgery. Unilateral maxillectomy was performed in a cohort of five Colombian boas suffering from maxillary osteomyelitis. This surgical technique should be considered as an alternative to medical treatment in boid snakes.

Pain and Pain Management in Sea Turtle and Herpetological Medicine: State of the Art

Simple Summary

Rescue and rehabilitative medicine of sea turtles must deal with several circumstances that would be certainly considered painful in other species (trauma, situations that require surgery); thus, it would be natural to consider the use of analgesic drugs to manage the pain and avoid its deleterious systemic effects to guarantee a rapid recovery and release. However, in these animals (as well as in reptiles in general), many obstacles stand in the way of the application of safe and effective therapeutic protocols. It has been demonstrated that, anatomically and physiologically, turtles and reptiles in general must be considered able to experience pain in its definition of an “unpleasant sensory and emotional experience”. Unfortunately, specific studies concerning sea turtles and reptiles on pain assessment, safety, and clinical efficacy of analgesic drugs currently in use (mostly opioids and non-steroidal anti-inflammatory drugs—NSAIDs) are scarce and fragmentary and suffer from some basic gaps or methodological bias that prevent a correct interpretation of the results. At present, the general understanding of the physiology of reptiles’ pain and the possibility of its reasonable treatment is still in its infancy, considering the enormous amount of information still needed, and the use of analgesic drugs is still anecdotal or dangerously inferred from other species.

Abstract

In sea turtle rescue and rehabilitative medicine, many of the casualties suffer from occurrences that would be considered painful in other species; therefore, the use of analgesic drugs should be ethically mandatory to manage the pain and avoid its deleterious systemic effects to guarantee a rapid recovery and release. Nonetheless, pain assessment and management are particularly challenging in reptilians and chelonians. The available scientific literature demonstrates that, anatomically, biochemically, and physiologically, the central nervous system of reptiles and chelonians is to be considered functionally comparable to that of mammals albeit less sophisticated; therefore, reptiles can experience not only nociception but also “pain” in its definition of an unpleasant sensory and emotional experience. Hence, despite the necessity of appropriate pain management plans, the available literature on pain assessment and clinical efficacy of analgesic drugs currently in use (prevalently opioids and NSAIDs) is fragmented and suffers from some basic gaps or methodological bias that prevent a correct interpretation of the results. At present, the general understanding of the physiology of reptiles’ pain and the possibility of its reasonable treatment is still in its infancy, considering the enormous amount of information still needed, and the use of analgesic drugs is still anecdotal or dangerously inferred from other species.

SAFETY OF MULTIPLE-DOSE INTRAMUSCULAR KETOPROFEN TREATMENT IN LOGGERHEAD TURTLES (CARETTA CARETTA)

Sea turtles are frequently presented for rehabilitation with injuries for which analgesic treatment is warranted. Ketoprofen is a nonsteroidal anti-inflammatory drug (NSAID) widely used in clinical veterinary medicine for musculoskeletal pain relief. Pharmacokinetics of 2 mg/kg IM have been studied in loggerhead sea turtles (Caretta caretta) as a single and a repeated dose q24hr for 3 days. Safety of longer term administration has not been performed, however, and NSAID use carries a risk of potential complications, including gastrointestinal ulceration, kidney damage, and bleeding. The objective of the current study was to determine the effects of a 5-day course of ketoprofen on thromboelastography (TEG) and hematological (including thrombocytes) and plasma biochemical analytes in loggerheads. A secondary objective was to determine 24-hr trough concentrations of ketoprofen after 5 days of treatment. Eight loggerheads were treated with ketoprofen 2 mg/kg IM q24hr for 5 days, and TEG, hematology, and plasma biochemistry panels were performed before and at the conclusion of treatment. Eight controls were treated with an equivalent volume of saline intramuscularly. Virtually no changes were detected before and after treatment or between treatment and control groups in any of the 24 endpoints evaluated, and marginal differences were not considered clinically relevant. Plasma ketoprofen concentrations after 5 days of treatment indicated no accumulation over that duration. Ketoprofen at 2 mg/kg IM q24hr for up to 5 days in loggerheads appears safe with respect to blood clotting and blood data, although other potential effects were not evaluated.

Pharmacokinetics of ketorolac in juvenile loggerhead sea turtles (Caretta caretta) after a single intramuscular injection

Ketorolac is a non-steroidal anti-inflammatory drug administered as an analgesic in humans. It has analgesic effects comparable to opioids but without adverse effects such as respiratory depression or restrictions because of controlled drug status. We designed this study to examine the potential of ketorolac as an analgesic for sea turtle rehabilitative medicine. Our objective was to determine the pharmacokinetics of a single 0.25 mg/kg intramuscular dose of ketorolac in a population of 16 captive-raised juvenile loggerhead sea turtles (Caretta caretta). A sparse sampling protocol was utilized, and blood samples were collected for 12 hours after administration of ketorolac. Samples were analyzed with high-pressure liquid chromatography (HPLC), and a nonlinear mixed effects model (NLME) was used to determine parameters for the population. With these methods, we identified a long elimination half-life (βT_1/2  = 11.867 hr) but a low maximum concentration (C_MAX  = 0.508 µg/mL) and concentrations were below the level proposed to be therapeutic in humans (EC₅₀  = 0.1-0.3 μg/mL) for most of the collection period. We conclude that ketorolac may not be an appropriate long-term analgesic for use in loggerhead sea turtles at this dose; however, it may have some benefit as a short-term analgesic.

Blind Trading: A Literature Review of Research Addressing the Welfare of Ball Pythons in the Exotic Pet Trade

Simple Summary

The Ball python is a small species that is commonly kept as an exotic pet across the world. Despite huge numbers of these snakes being kept and traded in the pet industry, there is very little information available about how catching, breeding, transporting and housing them in captivity could impact their welfare. Our study reviewed the published literature for this species and found 88 relevant peer-reviewed scientific papers. Physical health was the predominant focus of research, with numerous studies reporting on disease, injury or clinical treatments. Far fewer papers focused on other aspects of Ball python wellbeing, including behaviour, nutrition, environment or mental condition. We also found that very few studies focused on wellbeing prior to pet ownership, i.e., during the early stages of the trade chain when they are caught from the wild, transported, or bred in captivity. We recommend that more research is needed to assess the impact of the exotic pet trade on this species’ welfare. In particular, research on welfare conditions during capture and transportation of wild Ball pythons, and the potential effects of captive breeding, could help reduce suffering throughout the trade.

Abstract

Extensive numbers of Ball pythons are caught, bred, traded and subsequently kept in captivity across the world as part of the exotic pet industry. Despite their widespread availability as pets, relatively little is known about the potential welfare challenges affecting them. We reviewed the literature for research focused on the health and welfare of Ball pythons in the international pet trade. From a total of 88 articles returned from the search criteria, our analysis showed that very few actually focused on trade (10%) or animal welfare (17%). Instead, the majority (64%) of articles focused on veterinary science. There was a considerable bias towards physical health, with most studies neglecting the four other domains of animal welfare (behaviour, nutrition, environment and mental health). Furthermore, very few studies considered Ball pythons prior to resulting pet ownership, during wild capture and transportation or captive breeding operations. Our review demonstrates that our current understanding of welfare for Ball pythons traded as exotic pets is limited. We recommend that future research should focus on aspects of the industry that are currently overlooked, including the potential consequences of genetic selection during captive-breeding and the conditions provided for snakes prior to and during international transportation.

Pain and Its Control in Reptiles

Reptiles have the anatomic and physiologic structures needed to detect and perceive pain. Reptiles are capable of demonstrating painful behaviors. Most of the available literature indicates pure μ-opioid receptor agonists are best to provide analgesia in reptiles. Multimodal analgesia should be practiced with every reptile patient when pain is anticipated. Further research is needed using different pain models to evaluate analgesic efficacy across reptile orders.